No benefit in taking medications to increase uterus size

Dear Dr Mitchell,

I live in Canada and my wife currently lives in Russia. Recently she saw a gynaecologist there and was diagnosed with having a small uterus. She was prescribed progynova to increase the size of it and utrogestam to have her periods resumed. I started to research progynova and it made me suspicious. Do you think it is the right treatment for her?

Progynova contains the active ingredient estradiol valerate. This is a naturally occurring form of the female sex hormone oestrogen. As women get older, the ovaries gradually produce less oestrogen in the period leading up to the menopause and the level of the hormone in the blood decreases. This decrease in oestrogen levels result in irregular periods, hot flushes, night sweats, mood swings and vaginal dryness. Replacement of oestrogen helps to reduce the distressing symptoms of the menopause (time at which the menstrual period stops).

Progynova tablets are a continuous oestrogen-only form of hormone replacement treatment. This form of treatment should only be used by women who have had a hysterectomy (removal of the uterus). If the woman still has her uterus in place, a progesterone preparation should be given in addition to the Progynova for the last 12 to 14 days of each 28-day pack.

Oestrogen stimulates the growth of the lining of the uterus (endometrium) and this can lead to endometrial cancer if this is not counteracted with a progesterone preparation. The use of a progesterone supplementation does not eliminate the risk of cancer of the uterus entirely. Utrogestan is a progesterone compound which is prescribed for postmenopausal women taking oestrogen. It may also be prescribed to restore menstruation if your menstrual periods have stopped. It may cause drowsiness, dizziness, slight spotting or menstrual irregularities especially if taken excessively.

You did not mention your wife’s age. If she is in the menopausal age group (average age for the menopause is 51 years) then the small size of her uterus is really nothing to be concerned about. The uterus and the other pelvic organs tend to become atrophic (smaller in size) as oestrogen levels decline with age. There is really no benefit in taking medications to increase the size of the uterus.

Hormone replacement treatment has significant risks associated with it and should only be given for a short period of time when definitely indicated.

Caution should be exercised in patients who have a personal or family history of breast cancer, history of fibrocystic breast disease, history of fibroids, endometriosis or history of overgrowth of the lining of the uterus (endometrial hyperplasia), history of blood clots in the veins, women taking medicine to prevent blood clots (such as Warfarin), patients with systemic lupus erythmatosis, personal or family history of recurrent pregnancy losses, severe obesity, smokers, history of high blood pressure, history of high levels of fats in the blood or history of liver disease.

It should not be used in women who have known or suspected breast cancer or cancer of the uterus, untreated overgrowth of the lining of the uterus, vaginal bleeding of unknown cause, women who have recently had a stroke or heart attack, history of angina or active liver disease.

Your wife should discontinue the medication until she has had a complete gynaecological examination with detailed discussions with her doctor about the risks and benefits of using Progynova and Utrogestan.

Best wishes.

Dr Sharmaine Mitchell is an Obstetrician and Gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.